Form 4-C "Minor Political Party Nominating Petition and Statement of Candidacy for President and Vice President of the United States" - Ohio

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This is a legal form that was released by the Ohio Secretary of State - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
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Form No. 4-C Prescribed by the Ohio Secretary of State (09-17)
Minor Political Party
Nominating Petition and Statement of Candidacy
For President and Vice President of the United States
To be filed with the office of the Secretary of State not later than 110 days before the day of the general election and
not earlier than the date of filing of the minor party’s formation petition.
R.C. 3501.38, 3517.012, 3513.257, 3513.261, .263
Statement of Candidacy for President
NOTE - Each candidate must fill in, sign and date this statement of candidacy before petitions are circulated.
I,
, the undersigned, hereby declare under penalty of election falsification that
Name of Candidate for President
my residence address is
,
,
.
Street Number and Address, if any,
City or Village
State
Zip Code
(or rural route and number)
I further declare that I desire to be a candidate for election to the office of President of the United States at the
general election to be held on the
day of November,
.
Day
Year
I further declare that I shall be at least thirty-five years old, and shall have resided for at least fourteen years within
the United States by the 20
day of January after such election. I am a natural-born citizen of the United States.
th
I further declare that I am an elector qualified to vote for the office I seek, and I desire to be the nominee for the
Party.
Name of Minor Political Party or
Prospective Minor Political Party
Dated this
day of
,
.
Day
Month
Year
Signature of Candidate
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
Statement of Candidacy for Vice President
NOTE - Each candidate must fill in, sign and date this statement of candidacy before petitions are circulated.
I,
, the undersigned, hereby declare under penalty of election falsification that
Name of Candidate for Vice President
my residence address is
,
,
.
Street Number and Address, if any,
City or Village
State
Zip Code
(or rural route and number)
I further declare that I desire to be a candidate for election to the office of Vice President of the United States at the
.
general election to be held on the
day of November,
Day
Year
I further declare that I shall be at least thirty-five years old, and shall have resided for at least fourteen years within
the United States by the 20
day of January after such election. I am a a natural-born citizen of the United States.
th
I further declare that I am an elector qualified to vote for the office I seek, and I desire to be the nominee for the
Party.
Name of Minor Political Party or
Prospective Minor Political Party
Dated this
,
.
day of
Day
Month
Year
Signature of Candidate
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
We hereby designate the persons named below as a committee to represent us:
Name
Residence
Form No. 4-C Prescribed by the Ohio Secretary of State (09-17)
Minor Political Party
Nominating Petition and Statement of Candidacy
For President and Vice President of the United States
To be filed with the office of the Secretary of State not later than 110 days before the day of the general election and
not earlier than the date of filing of the minor party’s formation petition.
R.C. 3501.38, 3517.012, 3513.257, 3513.261, .263
Statement of Candidacy for President
NOTE - Each candidate must fill in, sign and date this statement of candidacy before petitions are circulated.
I,
, the undersigned, hereby declare under penalty of election falsification that
Name of Candidate for President
my residence address is
,
,
.
Street Number and Address, if any,
City or Village
State
Zip Code
(or rural route and number)
I further declare that I desire to be a candidate for election to the office of President of the United States at the
general election to be held on the
day of November,
.
Day
Year
I further declare that I shall be at least thirty-five years old, and shall have resided for at least fourteen years within
the United States by the 20
day of January after such election. I am a natural-born citizen of the United States.
th
I further declare that I am an elector qualified to vote for the office I seek, and I desire to be the nominee for the
Party.
Name of Minor Political Party or
Prospective Minor Political Party
Dated this
day of
,
.
Day
Month
Year
Signature of Candidate
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
Statement of Candidacy for Vice President
NOTE - Each candidate must fill in, sign and date this statement of candidacy before petitions are circulated.
I,
, the undersigned, hereby declare under penalty of election falsification that
Name of Candidate for Vice President
my residence address is
,
,
.
Street Number and Address, if any,
City or Village
State
Zip Code
(or rural route and number)
I further declare that I desire to be a candidate for election to the office of Vice President of the United States at the
.
general election to be held on the
day of November,
Day
Year
I further declare that I shall be at least thirty-five years old, and shall have resided for at least fourteen years within
the United States by the 20
day of January after such election. I am a a natural-born citizen of the United States.
th
I further declare that I am an elector qualified to vote for the office I seek, and I desire to be the nominee for the
Party.
Name of Minor Political Party or
Prospective Minor Political Party
Dated this
,
.
day of
Day
Month
Year
Signature of Candidate
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
We hereby designate the persons named below as a committee to represent us:
Name
Residence
Nominating Petition
We, the undersigned, qualified electors of the State of Ohio, whose voting residence is in the county, city, village, or
township, set opposite our names, hereby nominate
as a candidate
Name of Candidate of President
for election to the office of President of the United States and
as a
Name of Candidate of Vice President
candidate for election to the office of Vice President of the United States to be voted for at the next general election,
and certify said persons are, in our opinion, well qualified to perform the duties of the office or position to which they
jointly desire to be elected.
Signatures on this petition must be from only one county and must be written in ink.
Voting Residence
City, Village, or
Date of
Signature
Zip Code
County
Street Number and Address
Township
Signing
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
Circulator Statement
Must be completed and signed by the circulator.
I,
, declare under penalty of election falsification that I reside at the address
Printed Name of Circulator
signatures;
appearing below my signature; that I am the circulator of the foregoing petition containing
Number
that I witnessed the affixing of every signature; that all signers were to the best of my knowledge and belief
qualified to sign; and that every signature is to the best of my knowledge and belief the signature of the person
whose signature it purports to be or of an attorney in fact acting pursuant to section 3501.382 of the Revised Code.
Signature of Circulator
Permanent Residence Address
City or Village
State
Zip Code
OHIO REVISED CODE SECTION 3513.257 PROVIDES THAT “NO NOMINATING PETITION FOR THE OFFICES OF
PRESIDENT AND VICE-PRESIDENT OF THE UNITED STATES SHALL BE ACCEPTED FOR FILING UNLESS
THERE IS SUBMITTED TO THE SECRETARY OF STATE, AT THE TIME OF FILING THE PETITION, PRESIDENTIAL
ELECTORS SUFFICIENT IN NUMBER TO SATISFY THE REQUIREMENTS OF THE UNITED STATES
CONSTITUTION.”
Below is a list of electors pledged to the candidates herein before described:
Voting Residence
City, Village, or
Date of
Signature
Street Number and
Zip Code
County
Township
Signing
Address
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
,
.
Dated this
day of
Day
Month
Year
Signature of Candidate for President or
Signature of Candidate for Vice President or
Authorized Representative
Authorized Representative
WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE
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